Vous êtes sur la page 1sur 6

20 May 2010

California Edition

Calendar A Craigslist Moment For Medicine


Dozens of L.A.-Area Providers Post Prices On Line
May 22 Craigslist became a household name by another local urologist, Michael J.
connecting buyers and sellers of diverse Hyman, M.D.
items and services. HealthyPrice, Inc. Weintraub said the service is focused
RE)4:&J)/53:!(441(2!-<<1B(:/-4(2!(40! hopes to do the same for doctors and primarily on uninsured patients, although
)4./*-4D)4:(2!D)0/</4)!+&DB-+/1DC!S8!
>(./+6!?(<*(D)4:-!8(DB1+C!>/+<1++)+! patients. those who are underinsured or who have
E-*AB2(<)!3(T(*0!/++1)+C! The Burbank-based HealthyPrice has so large deductibles would likely use the
far enlisted about 100 physicians in the Los service as well.
K)5/+:)*!-42/4)M Angeles area. They have posted prices on California has a potentially huge
3::BMNNEEEC1<0D<C1<0(./+C)01N<D)N the HealthyPrice website for about 400 market for such services: a recent report
<-4=)*)4<)+N different medical procedures. by the UCLA Center for Health Policy
The prices Research concluded that the
range from number of
about $6 for uninsured
June 5-8 a fasting statewide
glucose test has soared
to $4,950 in the last
9(:/-4(2!;++-</(:/-4!-=!83(/4!>*15!?:-*)+! for the decade from
;441(2!@(*A):B2(<)!8-4=)*)4<)C!!?(4! removal of 6 million to
>/)5-!8-4.)4:/-4!8)4:)*C!;!0)D-4+:*(:/-4!
-=!4)E!B*-01<:+!=-*!0*15!*):(/2)*+!FGHIJ kidney and bladder stones (anesthesia 8 million. Even Californians with
F$6GHIC services included). Also included are pricey coverage often spend thousands of
but commonplace preventive care dollars a yet on out-of-pocket expenses.
K)5/+:)*!L42/4)M procedures, such as a colonoscopy Hyman said part of the reason for
($1,090, with anesthesia). The prices reflect setting up HealthyPrice is that even savvy
3::BMNND)):/45+C4(<0+C-*5ND(*A):B2(<)N
"#$#N*)5/+:*(:/-4C<=DOB(5)P0Q$ an approximately 30% to 40% discount off patients who have insurance can get
what an uninsured patient would be overcharged and not even be aware of it.
charged. One example: his wife had to undergo an
“Patients don’t want to haggle with MRI exam during an emergency room
June 23 doctors about prices and doctors don’t visit. Despite being covered by
want to haggle with patients,” said Philip I. insurance, her bill came to more than
Weintraub, M.D., a Burbank urologist who
U)(2:3!PR!K)+-1*<)!R)(<3JP4C!'*)B(*/45! founded HealthyPrice last year with
S40)*+)*.)0!8-DD14/:/)+!=-*!U)(2:3!PR!
(40!VUK!;0-B:/-4C!8(2/=-*4/(!V40-ED)4:6! Continued on Next Page
7-+!;45)2)+C!9-!<3(*5)C

K)5/+:)*!L42/4)M

3::BMNN+3/*):)(<3/42(C).)4:%*/:)C<-DN
NON-PROFIT HOSPITAL CEO SALARIES
A PAYERS & PROVIDERS EXCLUSIVE WHITE PAPER
E-Mail
info@payersandproviders.com with
the details of your event, or call $149 (Executive Summary) $275 (Summary and Salary Data)
(877) 248-2360, ext. 3. It will be
published in the Calendar section, Call (877) 248-2360, ext. 2 to order (all major credit cards
space permitting.
accepted).

!!!"#$#!%&!'(&)*+!,!'*-./0)*+!'1%2/+3/456!778
Payers & Providers NEWS Page 2

HealthyPrice (Continued from Page One)


Top Placement...
Bottomless Potential
$1,200. HealthyPrice offers MRIs starting have to deal with a third party and never
at $575. know whether they will get a procedure
Advertise Patients who use HealthyPrice agree or exam approved and paid for,” said
(877) 248-2360, ext. 2 online to the price for a procedure, pay it Robert Bitonte, M.D., a rehabilitation
in advance, and set up an appointment specialist who is president of the Los
with the physician. The patient receives a Angeles County Medical Association.
pre-arranged billing code to bring to the Despite Bitonte’s appreciation for
In Brief physician to verify the discount.
HealthyPrice handles the payment, minus
HealthyPrice, he cautioned that some
physicians may be reluctant to post their
a billing fee, and pays the doctor via prices in such an open manner.
check or Paypal. “I can sense it is going to be a cultural
“That’s the only paperwork the doctor’s shock, but on the other hand, it may save
CDPH Levies 10 practice has to handle,” Woodward noted, patients and physicians a lot of time,” he
adding that his company’s intent is to also said. “It also goes a long way to restoring
Administrative streamline administrative work for the patient-physician relationship. They
Penalties Against 9 physician practices. are talking solely about the procedure
Hospitals In addition to the agreements with the and exam, and both know how they are
physicians, Woodward said HealthyPrice going to be treated economically.”
The California Department of Public also has an arrangement in place with Bitonte also noted that patients using
Health has issued 10 administrative West Coast Clinical Laboratories to HealthyPrice could still be potentially
penalties against nine hospitals, provide discounted laboratory testing. overcharged due to miscommunication.
including the third and fourth penalty Dozens of tests are available through the However, Woodward said that there are
to Scripps Green Hospital in La Jolla. safeguards in place to prevent that from
service.
Scripps was penalized $50,000 for
allowing a physician with no Woodward expects to have all of Los happening.
experience using an instrument for a Angeles County – the nation’s most Others believe such an open concept
spinal drain to insert the instrument, populous metropolitan area – covered could jar other healthcare constituents
causing a portion of it to sheer off in with participating physicians by the end of into being more open.
the patient’s body. It received another
penalty for $75,000 for failure to train the year, with rollouts for the rest of “It’s a great idea,” said Wells
staff about cleaning a particular California and other states in the works. Shoemaker, M.D., chief medical officer
surgical instrument used in orthopedic HealthyPrice launched its services for the California Association of
procedures. A surgeon discovered the earlier in the spring, and has so far only Physician Groups. “I’d like to see it
instrument had retained dried blood applied to hospitals and health plans.
conducted about a dozen transactions,
while in the middle of a procedure. As
a result, 11 patients were exposed to according to Woodward. But industry They treat price data like industry
bloodborne pathogens, according to observers say it has the potential for secrets, and it creates all sort of
the CDPH. adding a desperately needed dose of price complications in the provisioning for
Alameda County Medical Center transparency to healthcare delivery. care. “
was levied a penalty of $75,000 when
it gave an intravenous “push” dose of “Something like this is refreshing to the
Dilantin to a patient that was meant to general populace and physicians who
be parceled out over a period of time.
The patient died as a result.

Medical Groups Claim Progress


Rady’s Children’s Hospital in San
Diego received a penalty of $50,000
for administering a medicine to treat
muscle spasms at 17.9 times the
prescribed dose. The medication for CAPG Survey Says Many Improve Patient Care
topical and intravenous use was stored
in the same cabinet, leading to the
error. The California Association of Physician Shoemaker, M.D., admitted that an essentially
Parkview Community Hospital in Groups reported in its annual Standards of self-administered test could be the subject of
Riverside received a penalty of Excellence survey a marked improvement skepticism, but noted that its membership has
$50,000 when a physician without among its membership in accommodating been responsive to the need for change.
proper privileges removed the wrong
patient needs. “There have been a lot of voices out there
kidney from a patient. The patient was
also not properly informed about the Eighty medical groups with 10.8 million asking us to improve, including consumer
risks of the procedure – including the patients statewide participated in the survey, advocacy groups becoming more vocal, and
potential for wrong-side surgery. which polled the participants on how they employers who in this economy cannot afford
Both Hi-Desert Medical Center in take care of their patients, their usage of to have their workers out for the entire day to
Joshua Tree and Tri-City Medical
health information technology and their see their doctor,” he said.
overall transparency, among other criteria. Respondents fill out a 19-page form. Among
Continued on Page 3 CAPG Chief Medical Officer Wells the criteria on which they’re scored:

!!!"#$#!%&!'(&)*+!,!'*-./0)*+!'1%2/+3/456!778
Payers & Providers NEWS Page 3

Longer ALOS!* CAPG (Continued from Page Two)


Advertise Of the participating groups, 25, or about
• If the medical group has a program to 30%, received the highest scores of elite, up
(877) 248-2360, ext. 2 target high-acuity patients (two or more from 20 the prior year. Such a score
chronic conditions) indicates a high competency in care
*For our ads, not your hospital
• If a disease management program is in management practices, transparency,
place and its specics accommodating patients; and health
• If its uses hospitalist physicians for information technology. Elites included
In Brief inpatients Beaver Medical Group in the San
Bernardino area; Coast Healthcare
• If hospital readmissions are analyzed
• If the medical group has a plan to continue Management in Orange and Los Angeles
function during a major disaster or other Counties; Healthcare Partners Medical
Center in Oceanside received disruption Group in Torrance; and Kaiser’s Permanente
penalties of $50,000 for failing to Medical Groups in Northern and Southern
• Whether or not it uses electronic medical
follow surgical protocols that led to
patient being burned during surgery. It records California.
was Tri-City’s second administrative • If it participates in the Integrated Another 14 groups received scores
penalty. Healthcare Association pay-for-performance of “exemplary” – high competency in three
Pomerado Hospital in Poway also program and shares data of four areas.
received its second administrative
penalty when a patient fell from a
chair that did not have a proper alarm
device attached. The penalty was
$50,000.
The other hospitals receiving
penalties were Marin General
Southwest Enters Pact With CMS
Hospital in Greenbrae; and Mission
Hospital Regional Medical Center in
Funding Loss Delayed in Lieu of Improvements
Mission Viejo.

Troubled Southwest Healthcare System has whether Southwest has improved its patient
reached an agreement with the CMS to care enough to continue participation in the
L.A. County DHS resolve the problems at its hospitals in Medicare and Medicaid programs in the long-
Forecasts Large Deficit Murrieta and Wildomar in exchange for term.
keeping its funding for another year. CMS had announced it would suspend
The Los Angeles County Department As part of the agreement, Southwest has Southwest’s participation in federal
of Health Services projects a looming
$204 million budget decit by the end agreed to retain experts in emergency reimbursement programs on June 1 due to
of the current scal year. The shortfall services; infection control; pharmacy/ ongoing quality-of-care problems dating to
is projected to reach nearly $600 medication administration; equipment 2007. Medicare and Medicaid reimbursements
million in 2010-11. maintenance; leadership and accountability; account for about 40% of Southwest’s
DHS hopes to close that gap with a
and quality assessment/performance revenue, according to data from the Ofce of
proposed hospital provider fee and
some federal supplementary funding. improvement. Statewide Health Planning and Development.
“Clearly this year almost everything Each expert will report to a lead The California Department of Public
is focused on the hospital fee,'” said consultant, who will report the preliminary Health, which has levied six administrative
interim DHS director John Schunhoff. ndings directly to the Centers for Medicare penalties against Southwest, has also moved to
“We are concerned about that.''
Los Angeles County Supervisor Zev and Medicaid Services over the next two revoke its operating license. Southwest is
Yaroslavsky proposed the DHS staff months. continuing negotiations with CDPH, but has
returns in 30 days with a report on CMS will also conduct an extensive been unable to reach an agreement, ofcials
specic steps they will take to close survey in the spring of 2011 to determine said.
the budget decit if the revenue
streams do not materialize.
"We are dependent on the state to
negotiate ... key initiatives. We are not
at the table and not privy to critical
information ... that would make or
break the county's health care
system,” Yaroslavsky said. Expert Healthcare Communications
In past years of large budget
decits, DHS has cut outpatient
services and outsourced other services !White Papers !Media Campaigns !Newsletters
to private-sector providers.
(818) 848-8510 www.rfsconsult.com

!!!"#$#!%&!'(&)*+!,!'*-./0)*+!'1%2/+3/456!778
Payers & Providers OPINION Page 4

9-21:)!"6!;++1)!"# Cleaning Up The Administrative Mess


New Applications Can Make Streamlining a Reality
'(&)*+!,!'*-./0)*+!/+!
<1%2/+3)0!).)*&!=31*+0(&!%&!
'(&)*+!,!'*-./0)*+!'1%2/+3/456! One of the fundamental challenges facing of resistance to online business functions,
778>!?4!(441(2!/40/./01(2! every conscientious benefits administrator there is actually an expectation that these
+1%+@*/<A/-4!/+!BCC!(!&)(*! is keeping up with the massive amounts of functions should occur there.!
DB$EC!/4!%12FG>!;A!/+!0)2/.)*)0! paper and data accompanying this Another challenge is reconciling the
%&!)H:(/2!(+!(!'IJ! function. carrier bills.! A well-designed benefits
(AA(@3:)4A6!-*!(+!(4!)2)@A*-4/@! Coupling this issue with the rapidly administration system should eliminate this
4)K+2)AA)*> changing legislative landscape from the monthly headache or at the very least
ARRA, healthcare reform and other minimize the effort expended. In an ideal
?22!(0.)*A/+/456!+1%+@*/%)*!(40! sources means that the situation, benefits administrators
)0/A-*/(2!/4L1/*/)+M administration of benefits will be able to self-bill – sending
continues to become more a system generated invoice that
DNOOG!"ENH"PQ# and more difficult. matches the data the system
/4R-S<(&)*+(40<*-./0)*+>@-: The use of technology can regularly transmits to the carrier –
greatly improve the benefits thus eliminating any need to
T(/2/45!(00*)++M
management function. reconcile bills.!
N$N!U>!V-22&K--0!W(&6!X1/A)!Y There are many High-quality benefits
Y1*%(4F6!8?!C$Z#Z advantages of using an administration systems will also
online benefits enforce eligibility rules,
W)%+/A) administration system. First preventing the accidental
KKK><(&)*+(40<*-./0)*+>@-: and foremost is having all of coverage of an employee in a
J(@)%--F your benefits information in plan or during a period when
KKK>R(@)%--F>@-:[<(&)*+<*-./0)*+ one database, enabling they should not be covered. In
=K/AA)* accurate reporting, excellent addition, these systems enforce
KKK>AK/AA)*>@-:[<(&)*+<*-./0)*+ customer service, sound the completeness and accuracy of
fiscal management, and By data collection.!
reduced paper handling. . Most of today’s online systems, like
\0/A-*/(2!Y-(*0 Few organizations source all of Henry Keenan’s BenefitBridge, do not require IT
XA).)4!=>!9(2)4A/4)6!'*)+/0)4A6! their benefits from a single Loubet involvement since they run as hosted
=3)!8(:0)4!]*-1< insurance carrier, and gaining an solutions with no infrastructure
instant, holistic view of an overall benefits investment required to support them.! The
^-++!]-20%)*56!83(/*:(4!-R!A3)! program is almost impossible. For have proven to be very effective for a wide
Y-(*06!7-+!^-%2)+!V-+</A(2!,! example, answering simple questions like range of organizations.! For example, the
T)0/@(2!8)4A)* “How many management employees are Keenan BenefitBridge has been in place for
enrolled in the PPO plan?” is very difficult five years and is linked up with the five
_/:!7-AA6!\`)@1A/.)!9/@)!'*)+/0)4A6! without an online tool.! largest California health plans.! It currently
V-+</A(2!?++-@/(A/-4!-R!X-1A3)*4! Providing good customer service is serves some 200,000 members representing
8(2/R-*4/( equally difficult. Simply answering an 200 different employers with groups ranging
employee's questions when they call from 100 to 20,000 members.!
\2(/4)!Y(A@32-*6!T>I>6!83/)R!
T)0/@(2!aRR/@)*6!7>?>!8(*)!V)(2A3! typically requires the search for a paper The best time of the year to install one of
'2(4! file and digging through stacks of forms. these systems is immediately following the
Employees should be able to go online anniversary date of benefit plans, taking
b)/A3!^/@3:(46!T>I>6!\`)@1A/.)! and see what benefits they are eligible for, advantage of periods of time when there is
9/@)!'*)+/0)4A6!7(F)+/0)! detailed comparisons of plan benefits and less activity.! Don’t miss the next opportunity
8-::14/A&!V)(2A3@(*) costs, what benefits they are currently to automate these critical functions.
covered under, and which of their
V)4*&!7-1%)A6!83/)R!XA*(A)5&! dependents are covered. During open
aRR/@)*6!b))4(4!,!?++-@/(A)+ Henry Loubet is Chief Strategy Officer for
enrollment, they should be able to make Keenan & Associates. He is a member of the
changes without having to receive, fill out Payers & Providers Editorial Baord.
'1%2/+3)*[\0/A-*H/4H83/)R and return stacks of paperwork.!
^-4!X3/4F:(4 In today’s online world, most employees
Op-ed submissions of up to 600 words are
)0/A-*S<(&)*+(40<*-./0)*+>@-: are banking, shopping, reviewing
welcomed. Please e-mail proposals to
children’s schoolwork and performing a
editor@payersandproviders.com, or call
myriad of other activities online. Instead
(877) 248-2360, ext. 3.

!!!"#$#!%&!'(&)*+!,!'*-./0)*+!'1%2/+3/456!778
Payers & Providers MARKETPLACE/EMPLOYMENT Page 5

REVENUE
BENCHMARKING On-line database of paid claims

FOR HOSPITALS Your Hospital


A Service of the
Your Hospital
• market intelligence
• strategic planning
• business development
• contract negotiation

PDS users are reporting millions of


dollars in reimbursement increases,
for a significant ROI.

Find out how you can too.

www.pds-data.com
213-283-8003

PROFESSIONAL®
DATA SERVICES

It costs up to $27,000 to fill a healthcare job*

will do it for a lot less.

Employment listings begin at just $1.65 a word

Call Ron Shinkman at (877) 248-2360, ext. 2,


e-mail him at: advertise@payersandproviders.com

Or visit: www.payersandproviders.com

*New England Journal of Medicine, 2004.

!!!"#$#!%&!'(&)*+!,!'*-./0)*+!'1%2/+3/456!778
Payers & Providers MARKETPLACE/EMPLOYMENT Page 6

LOOKING FOR A NEW POSITION?


can help.
We publish advertisements for those seeking
new career
opportunities for just $1.25 a word.

If you prefer anonymity, we’ll handle all


responses to your ad. Discreetly.
Call (877) 248-2360, ext. 2, or e-mail
advertise@payersandproviders.com.

!!!"#$#!%&!'(&)*+!,!'*-./0)*+!'1%2/+3/456!778

Vous aimerez peut-être aussi